S.O.S. - Kinney has anorexia/anemia

dan32

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I am documenting my ongoing story of my 5yo male cat Kinney, of whom I am very fond.  He has two 4yo male housemates who are brothers.  All three get along swimmingly. 

This all started in late spring with the three of them hauling up mice from the basement, one after the other - a seemingly endless supply of mouse toys.  In all I would say they have caught more than 20 mice this summer - as if I have a mouse expressway into the basement.  They play with them like delicate toys, never eating them but being very careful to make the mice last as long as possible.  I noticed one day that my dry food bowls were going untouched for several days.  Nobody was eating!  At the time, I just figured they were having such a great time that they didn't have time for food.  After awhile though, I started to worry.

The "brothers" resumed eating afterward, but Kinney's appetite slacked off to nothing.  I also noticed him having coughing fits in the middle of the night, so by mid-June I was concerned enough to take him into my regular vet.

June 18: Told doctor my story about the mice, the group food strike, and asked specifically to check Kinney for lung congestion as well as reason why he wasn't eating.  Doctor said his lungs sounded very clear, said he looked good - but gave me Bayer Profender (a flea and tick topical) for all three cats in case they might have caught some parasite and was sent home.  Kinney weighed 9.6 pounds, one pound less than a year before.

June 24: Regular vet now unavailable due to a trip of his, so took Kinney into an Emergency Facility.  Still not eating.  ER took bloodwork from him and did two very clear x-rays of his midsection.  The x-rays were unremarkable, but his bloodwork indicated he had anemia.  They gave him a shot of Convenia antibiotic and sent me home with two cans of Science Diet A/D.  They offered up a script for Cyproheptadine (an appetite stimulant), but I declined due to bad experience with another one (Mirtazine) years ago with former cats.

June 27: Read up on anemia and took a fecal sample in to my vet's office in case there were any intestinal parasites the Profender didn't cure.  Results came back negative.  Vet's office received bloodwork results from the ER visit, but not the x-ray images.  Apparently x-rays are routinely not forwarded.  Kinney's eating is sparse.  Very worried.

June 28: Called back to the ER's doctor and said I would try the Cyproheptadine, and asked that it be made into a topical that I could apply to his ear.  I had had great success with topicals in the past with another elderly cat's thyroid medicine, so decided to try.  Gave him one dose on his ear and 15 minutes later, he was eating - a miracle!  His eating improves with the appetite stimulant, but does not totally recover.  At least he is eating something...

July 9: Regular vet still on his trip, so booked a follow-up appt. with a substitute vet.  Told her Kinney was eating fairly good on the Cyproheptadine, but sounded like he had a plugged up nose.  She was very concerned about the anemia.  She prescribed Doxycycline (also as a topical), which is often used for respiratory or sinus infections.  I could see the logic there.  Kinney weighed 8.5 pounds at that visit, another pound lost in three weeks.  He was eating some, but not enough to sustain his weight.  Doctor took bloodwork and ordered a full infectious disease panel.  Results came back negative for FeLV, FIV, FCV, Toxoplasma, Cryptococcus. 

July 10-July 15: Once I start the Doxycycline dosing, Kinney's appetite again tanks and it was as if the Cyproheptadine no longer works.  He is barely eating at all.

July 16: Regular vet has returned and said my next step was to do an ultrasound.  I read up on what an ultrasound would be finding and seemed like mostly cancer.  Meanwhile, I had stopped over at the ER and gotten copies of the x-rays and reviewed them with my regular vet.  He did not see anything remarkable.  Kinney continues hunger strike.  Extremely worried.  Doctor said maybe better take Kinney to a larger ER facility since he is in such a weakened state.  Discontinue the Doxycycline treatments, but continue the Cyproheptadine appetite stimulant.  Barely eating - batteries dwindling.

July 19: Called the larger ER facility and booked an ultrasound appt. for July 22.  I am frantic by this point.  Kinney is an absolute stick figure and has taken to hiding under the bed, which I know is a very bad sign. On the bright side he still purrs, cleans himself and seems alert although sleeps alot.  Hardly eating at all.  Not sure he will even make it for his ultrasound appt. on Monday. 

July 20: Surrender and take him into the larger (and very expensive) ER.  He has very bad anemia by this point.  Leave him there overnight for a blood transfusion and Ringer's drip to see if we can shore him up for his ultrasound appt.  ER not sure that the transfusion will cure his appetite.  Big money.  Just buying time.

So far, four doctors have seen him and no one is sure what is wrong.  Other than he is anorexic and has anemia.  We have ruled out the regular infectious diseases that usually cause anemia, so are moving on to cancer.  He is only 5yo.  I will update this "diary post" with what happens next.  I felt it was worth the transfusion if he should need surgery or something - he is weak - maybe it will shore him up.  He is a darling and has hung on patiently for over a month.  I will re-evaluate once I have some diagnosis.
 

vball91

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So sorry to hear of Kinney's health issues. I am surprised that none of the vets mentioned syringe feeding or a feeding tube. Isn't Kinney at risk for hepatic lipidosis given his rapid weight loss?
 

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I really think it is malpractice that vets do not advise syringe feeding or feeding tubes- these will prevent all of the issues that crop up when cats go off food and will buy you time to figure out what is really going on instead of treating the effects of not eating. Here is a great article written by a vet on how easy it is to insert a feeding tube and that it is a life saver (http://catinfo.org/?link=feedingtubes). I would advise you demand a feeding tube right away. 
 
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dan32

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Jul 22: Kinney had his ultrasound today and they found a large tumor growing on the right side of his abdomen.  Dr. wasn't clear if the tumor was growing on the intestines or was something growing alongside of it (up until recently, he had been making normal feces so I assume whatever it is isn't blocking).  The doctor thought it was lymphoma, but said they couldn't be sure what type of cancer it was without surgically removing it and sending it out for biopsy.  He gave me the options of: 1) pts 2) go home with prednisone and see how it goes 3) surgery and chemo.  He didn't sound too hopeful.

Since Kinney was looking pretty bright from his transfusion and since I am not a big fan of pts, I chose to spring him from the ER and bring him home for some last days with his brothers.  He is ecstatic to be home, purring away like crazy.

How he was doing last week was getting very thin and tired and sleeping alot.  I asked if that was what I might expect - that the anemia would reoccur and he would sort of drift away getting weaker and tired-er.  Doctor said the prednisone may shrink the tumor and I get anywhere from two days to several months out of him and it jump starts his appetite  - or - not.

In any event, the ER (PSEC in Levittown, Pa.) was a very busy place, noisy, impersonal, and frightfully expensive.  At that moment, I thought to just spring Kinney-Kin from prison and see how it goes.
 

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Oh I'm so sorry for the sad news. :( :hugs:

I don't want to give you false hope, but if you want to at least discuss chemo with someone who knows what they're doing, the oncologist we used for our Lazlo moved from Red Bank, NJ to

http://www.vcvrc.com/newseventstl/news-and-events/news/ and
http://hopevs.com/our-doctors/oncology/dr-craig-clifford/

Both are near Allentown, I think. I'm not sure how far that is from you. But for us, it was worth the (minimum) 1.5 drive we had from where we live to see him when he was in Red Bank, NJ.

Two years ago, this month, Lazlo was very sick. In the three vet visits it took to get him diagnosed over the course of a month, he deteriorated REALLY rapidly. :( He'd gone from 14 pounds to 9, and was living under a chair with no interest in anything. They were able to do a needle biopsy at the time of his ultrasound, and confirmed it was large cell lymphoma. We were referred to Dr. Clifford, an oncologist. We were there the next day, basically. The bottom line is that Lazlo had a mass in his stomach so large, that without treatment, he was given 4 weeks to live. The way things were going, I'm not sure he would have made it that long. He surely had no quality of life by then.

Dr. Clifford explained the potential outcomes. There was a 50% chance of remission, which would likely last about 9 months. We came to call Dr. Clifford Dr. Gloom, because we were doing monthly ultrasounds, and his tumor wasn't shrinking as rapidly as he hoped. So we stopped doing the monthly or bi-monthly ultrasounds. Lazlo clearly felt better, so we decided just to complete the entire course and then see where things stood. Well, he went into complete remission. No mass to measure.

During treatment he did need anti-nausea medication (cerenia - GREAT drug), an appetite stimulant (mirtazipine - makes some kitties nuts, but was great for Lazlo), the steroids... and we did have to syringe feed him for the first few weeks, and at various points along the way. Oh - and he had bleeding ulcers, which also needed treatment. The tumor was fused to the stomach wall, so surgery wasn't an option.

If Lazlo had completely stressed at the visits, we wouldn't have put him through it.

If he had not seemed to be feeling better, or wasn't handling the chemo, we wouldn't have put him through it.

I understand the decision to not use chemo. It is expensive, and there are no guarantees.

But I wanted to put it out there - to consider asking your vet for a referral to Dr. Clifford, or call to see if they can do the biopsy or surgery.... to at least discuss with someone who is a specialist what the potential outcomes and chances are, rather than not trying - if you're so inclined.

We figured it couldn't hurt to start treatment, we could always not complete it.

For us, it was worth every penny and all the time. Lazlo is 12.5 pounds, energetic, happy, playful... and healthy. We did switch him to a raw diet towards the end of the chemo so he wasn't eating anything that would contribute to a return of his cancer. But every day with him is a gift, and a gift courtesy of Dr. Clifford.
 
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dan32

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Thanks LDG for the inspiring case history.  My vet indicated that if I wanted to go further with treatment that I should see an oncologist.  Both of Dr. Clifford's offices are a little more than one hour's drive from me (New Hope, Pa.)  It got me thinking, so I looked up oncologists on acvim.org.  There a couple even closer to me.

Kinney ate some today, but I built up my courage and gave him a syringe feeding today to supplement what he would take on his own.  I could see that the ER had him constantly wrapped up in a towel to handle him, so I tried likewise.  Sort of clumbsy on my first try, but it would seem that if I was going to go down that road, it is probably a skill I should acquire.

He is still very tickled to be home.  I wonder how much time the transfusion has bought me?  It would seem like the more I could "fatten him up", the better if he would eventually require surgery.  He is stick thin at this point.
 

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Yes, he needs nourishment right now. That, along with the prednisone, will help him feel better - and help him put on weight. :nod:

I don't know what Kinney's numbers look like, but for Lazlo, even if surgery was an option (from the tumor point of view), surgery wasn't an option because his platelet count was so low, surgery wouldn't have been an option anyway (he risked bleeding out from not being able to clot his blood).

You might also want to chat with your vet about the anti-nausea med (Cerenia) and an appetite stimulant (Mirtazipine - given every 3 days, an old-line human antidepressant that makes some cats loopy, or Cyproheptadine, given every 12 hours; it's an anti-histamine). For Lazlo, the anti-nausea med really changed his attitude towards food. Of course, for Laz the problem was in his tummy, so I don't know that Kinney feels nauseous (signs are any of: drooling while eating, smacking lips, licking lips frequently, sitting hunched up in a "meatloaf" position, usually with head slightly down. Many kitties "meatloaf," but look relaxed doing it - that's not nausea. You'll see he looks uncomfortable (IF he is) when you look for it). ...But these treatments are something to discuss. :nod:

:hugs: for you and :vibes: for Kinney!
 
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dan32

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Kin so far seems perked up by the prednisone.  The ER didn't give me very much of it - only five days worth.  I guess they figured he was not going to last.  What has me very concerned is that right after eating (either on his own - or with the syringe), he seems to want to chase it down with a lick of kitty litter.  I keep thinking this can't be good for his digestion.  Maybe I will try syringing in a tspful of pumpkin to keep things moving.

I was going over his billing from the ER and they were giving him Famotidine (1/3 of 10mg) as an injection on a daily basis, which is Pepcid.  Also his lab results say he had a duodenal ulcer.  I wonder if the kitty litter is his attempt at an antacid?   But the duodenal ulcer must be what is giving him the anemia.  My friend had a duodenal ulcer, also anemia and they gave her a transfusion in the hospital.  That said, they don't usually operate on people who have ulcers - isn't a bland diet of eating small portions the old cure? 

It's just that the anemia is the thing with the time constraint. 

I wonder if I could cook something up for him like chicken and rice and puree it.

 I suppose I'm just babbling to myself.
 

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It is interesting he wants kitty litter. Some natural remedies for upset stomach include clay based products. You may want to look into vitality science as they have a product that is clay based to help with stomach issues (http://www.vitalityscience.com/v/AllProducts/luxolite/white-bentonite.asp). They also actually have a cancer support treatment (http://www.vitalityscience.com/v/AllProducts/feline-immune/cat-cancer.asp). I read a lot of good reviews on these products and I bought the vomiting and diarrhea protocol for my cat after he had a recurring hairball issue and I suspected he had ibs. I shaved him which seemed to cure all of his stomach issues so I have't started him on it yet, but I did give the luxolite clay to my dog who had really bad diarrhea and it cured it right away.

I can also vouch for cerenia and cyproheptadine as great medications to stop nausea and get them to eat. 
 

franksmom

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Oh also forgot to add that nature's variety wet and raw food also has clay in it. There is some controversy on here on this but it may be something you can try right away to see if it stops his craving for litter. 
 

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The PICA (eating litter) is from the anemia.

Given he had ulcers (Lazlo did), you should definitely use Yunnan Baiyao and pepcid a/c (well, famotidine. The pepcid is odd-shaped, so not fun to pill. The generic is round and less expensive!) I don't know if sucralfate will help with duodenal ulcers, but it's worth discussing a prescription with your vet. :nod:

The Yunnan Biayao was prescribed for Lazlo by our holistic vet, and the oncologist said it wouldn't interfere with his treatment. It is a very widely known and used Chinese herbal - both for humans and pets. Here's the quick wiki on it: http://en.wikipedia.org/wiki/Yunnan_Baiyao

I buy it on Amazon:
Give him one capsule every two days for 3 pills, then one capsule every three days for 3 pills, then one capsule every 5 days (if he's still anemic then). I'd give him the little tea pill in the middle immediately - that will help stop the bleeding.

You can give him the 10mg famotidine once a day. To provide 24-hour protection, it should be give at least an hour before or after a meal.

The Yunnan Baiyao, the famotidine, and the sucralfate had Lazlo's ulcers healing to the extent that his hematocrit went through the roof inside of two weeks.

I suspect the ER vet only gave you five days because they expect you to see your own vet.

And yes, for now, you can boil him chicken. :nod: Shred it up, and give it to him with the broth. You can puree it and syringe feed him with it as well. If you'll be feeding it for more than a few days, you can easily add the right amount of calcium by adding 1/2 teaspoon of ground eggshell powder per pound of chicken (the weight before boiling). If you'll be making smaller meals, it's 1/32 teaspoon per ounce.

You can either make your own: http://holisticat.com/esp.html or buy it (the last item in the e-shop): http://www.knowwhatyoufeed.com/shop_online.html

If he likes it, you might want to feed him freeze dried (or fresh: raw OR cooked) beef liver. The right amount (of fresh, meaning weight before cooking if you cook it) would be 5% - 10% of the weight of the chicken (before cooking) you're making. This will also help the anemia (and his overall nutrition!). If he doesn't like it, many cats like freeze dried beef liver when they don't like fresh. These are easy to use (though a bit expensive): Three-to-five treats a day will really help him, if he likes and eats them. :nod: (Otherwise you can mush them into the food you syringe feed him). I would definitely not feed this much liver without adding calcium to the chicken (if you go that route). Organs have more phosphorus than meat, and without the calcium, will cause diarrhea.

I use these mini-measuring spoons to balance individual meals. The "smidgen" is 1/32 teaspoon:
I'd pay for expedited shipping for the Yunnan Baiyao, and I'd chat with the vet ASAP about using sucralfate.

Many vibes for you and your boy. :vibes: :vibes: :vibes: :vibes: :vibes:
 
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dan32

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Thanks again for the hope.  Status is I started back on the topical Cyproheptadine along with the prednisone.  He is ravenous - eating alot.  I am sort of embarassed I let him go so long in such an emaciated state - yet in review all of the vets just kept sending me home without much guidance.

I happen to have Pepsid A/C around from a previous elderly cat with CRF.  If I remember correctly, I was giving my CRF cat just 1/2 pill daily and it seemed to make him burpy.  I am a little afraid to upset the apple cart since things are going OK.  I did order the Yunnan Baiyao caps from Amazon last night, but will probably be afraid to give it to him, since I do not have a holistic vet at the ready to hold my hand.  My thought with the whole ulcer thing was if I could stop his bleeding, then maybe I would have some time to make some decisions.  As it is, I only have another two doses of prednisone left and am not sure how to proceed with his care.  I had a discussion with my vet yesterday who was happy to represcribe the Cypro, but I have not approached him for prednisone.  Does he just call that in to someplace like CVS or what?  My vet still had a dim view of the whole thing - he may be convinced to ride along or I may have to find another vet.

Just thought to publish the diagnosis from the ER (VSEC in Levittown, Pa):

______________________________________________________________

"Kinney presented for lethargy and anorexia that has progressed over the last month.  On presentation from his regular veterinarian his PCV was 13%, radiographs were unremarkable of the chest and suspicious for a mass effect in the abdomen.  The globulins were also elevated and the infectious disease panel was negative.  He was given a blood transfusion and continued on Doxycycline and IV fluid therapy.  (Doxy only given while in ER since at the time, we weren't sure what was wrong - no longer receiving).

The abdominal ultrasound showed an enlarged liver and spleen, enlarged abdominal lymphnodes, and a duodenal mass with ulceration.

At this time you have declined surgery and biopsy and have elected to take him home on prednisone."

Prescribed Medications:

Prednisone susp 20mg/ml    Directions: 0.35 mls orally once a day until instructed otherwise

_____________________________________________________________

I also have a printout of his bloodworks including many readings I am not sure what they mean.  I remember the doctor at the ER saying his PCV was 16% and holding steady after his transfusion.  How much time do I have?

At the time sitting in the ER, the doctor told me that they couldn't be sure what he had unless they operated on him, cut out the tumor and sent it out for biopsy.  He just seemed too weak at the time to risk putting him under.  He hadn't even eaten much of anything in weeks.  He looked like a concentration camp victim.  My decision was to bring him home to either see if he perked up from the prednisone and re-evaluate surgery, or to expire at home.  The prednisone seems to be doing something for him.

LDG: I read all 21 pages of Lazlo's progression through chemo and what must have been a terrific amount of vet visits, setbacks, and triumphs - I can't even imagine the costs.  It would seem that the closer the vets, the better.  You had mentioned that the oncologist wanted a positive diagnosis before seeing Lazlo.  I do not have that, but the ER doctor thought most likely lymphoma.  I asked if they could do a fine needle aspiration and he said no, they would need tissue sample (surgery).  I couldn't do it - I thought it would kill him right at that moment.

I am not sure exactly how to proceed.  With all the ultrasounds required for Lazlo, I think I would probably get my local vet to re-do them for a starting point rather than keep taking him back to VSEC in Levittown at $330 a pop.  A very close friend had a cat she nursed along with lymphoma for years under the care of a knowledgable local vet who did her own ultrasounds and also administered the chemo treatments in the local office and she said she was paying $90 for ultrasounds.  I can see where all these costs rack up fast.
 

ldg

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Actually, we ended up "only" having 4 ultrasounds done: the one that found the mass, one after each of the first two months of chemo, to verify he was responding to the treatment, and the one done 3 or so weeks after the completion of the chemo.

Yes, it was expensive, and I completely understand not pursuing more aggressive therapy because of the cost, with not only no guarantees, but ultimately probably just a 50% chance it works, and then the average lifespan being another 9 or so months.

In the end, Lazlo had turned into a bag of bones so quickly, we were not at all prepared to say good bye. We've rescued cats for a long time, we know our vets very well, and they all know we will do anything to save a cat if at all possible. We have very limited income, we just have different priorities than most people. So who knows what our vets thought to themselves about Lazlo's chances. As you saw, his mass was deemed "massive," and he was given very little time without treatment.

Now, all of that said, you know your cat, you know your financial situation. It sure sounds to me like Kinny is responding to treatment, given the description of him being "ravenous." That's good!

You can take a "wait and see" attitude before deciding on surgery for the biopsy, because no one, local or other, can treat Kinny for cancer (if the mass is even cancerous) without the diagnosis.

But to improve his chances, that ulcer MUST be treated. If you cannot have a comfortable discussion with your vet, and if he does not support your choice to be proactive (in steps) rather than just give up, get a new vet. Now.

If you're not comfortable with Yunnan Baiyao, return it. It's safe and frequently used, but any treatment is best under advisement of a vet. It's your choice. But it isnt toxic.

To heal the ulcer, he needs something to suppress acid production. That is what the famotidine is for. I dont know why your CRF kitty needed pepcid, but what you need is vet advice on the appropriate dose for this kitty, for this condition.

And to heal the ulcer, he needs the sucralfate to coat it to protect it so it can repair.

And the prednisolone or prednisone is simply standard anti-inflammatory treatment to help reduce inflammation, perk them up, make them feel better, and hopefully slow down the rate of growth of the mass.

So your next step is to decide if you want to take steps to give him a fighting chance, if he wants to fight; or if you want to make him as comfortable as possible while whatever disease this is takes him. There's nothing wrong with palliative care - but treating with pred would be a part of that.

So you need to talk to your vet and determine if he or she is on board as your partner in taking steps to give Kinny a chance, or if your vet has just given up. Then find a vet that will work with you, one day, one step at a time.

.
 
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ldg

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P.S. You can keep tabs on the ulcer without ultrasounds. His hematocrit should start to go back up if the bleeding has stopped. It should cost $15 - $20 to have just the hematocrit run at the vet (without an appointment for an exam).

If he is seeing someone "regularly" for ulcer treatment - or at least that first exam to review his current health status and discuss treatment and future potential options - I would not expect them to charge you for an exam every time a hematocrit should be run. This is, of course, with the assumption that whatever vet will be seeing him if the ulcer can be managed and if he gains weight that at that point you will evaluate (with the vet) whether or not to pursue definitive diagnosis so you have further treatment options - if Kinny feels better. Then I would think they shouldn't insist on an exam accompanying the hematocrit check-ins.

But all of this should be discussed openly. Vets understand that finances figure into treatment decisions, and they can help narrow down options based on your priorities.

:hugs: :heart2: :vibes: :vibes: :vibes:
 
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dan32

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I had asked my home vet if he would perform a tumor removal (he is an excellent surgeon) and he declined saying I would need to go to an oncologist surgeon - that he was not equipped to deal with what he might find.  Thus my sort of confusion, since your oncologist wanted a definitive diagnosis before taking you on.
 

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OK. But he can prescribe pred, and everything else your cat needs to treat the ulcer. And he can refer you to an oncologist surgeon. Obviously if the local vet cannot perform the surgery required to get the definitive diagnosis, they should be able to refer you to someone who can. And he can be treated for his ulcers and given normal, supportive, "palliative" care in the meantime.

If your vet didn't or won't refer you to someone, start making phone calls to oncologists, as you don't want to contact Dr. Clifford given the distance. Find out what needs to be done.
 

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Hi Dan, 

I'm so sorry your cat has lymphoma. My cat Toby, a very special sweet boy, recently died of lymphoma after a year of treatment with chemo, prednisolone, sucralfate, pepsid and a large number of other palliative medicines. His thread is on here. I still have many tears left to shed before I will be over this. But I hope my advice will help you.  http://www.thecatsite.com/t/243465/toby-vomiting-and-losing-weight-fine-otherwise

Since your cat may have an operable tumor (my Toby had diffuse lymphocytes throughout his intestinal tract, hence unable to operate :-() I think with surgery you might have a shot at getting a nice long remission for your kitty. It sounds as if you definitely need the ultrasound. And in this same vein, you need to have the ultrasound wherever you have the surgery. We learned this the hard way, that in order to compare ultrasounds, any follow up test needs to be on the same equipment as the original or you will be told the result is inconclusive and that is why. 

You might just want to go that extra distance and see the doc that LDG is recommending, for the big stuff you need to have done. If you are not going to do chemo, you are likely not going to need to be there extremely frequently- just for the ultrasound, the surgery, and maybe at some point a follow up ultrasound. Plus she can give you tips about navigating their facility and the way they do things, which, let me tell you, is pure gold. I did not have benefit of this experience, my choices were somewhat limited as I was opting for chemo, and the place we ended up at- mind you, with great recommendations- just got worse and worse, and was anything but great. 

With Toby, we drove an hour or so for each treatment. But after he finished his chemo and we were just doing palliative care, we used a local vet for his every day needs. LDG may be able to shed some light on you doing an arrangement like this between the doctor she recommends and a local vet. 

With the prednisolone, we were not told this by the cancer center we went to, but if your cat is crying a lot and eating a lot and seems jumpy, you might be able to dial back the amount you are giving him, especially post surgically. My oncologist never spoke to us about these kinds of things and I had to reach out to get any kind of response. 

Did they talk to you about large cell or small cell lymphoma? The former is more aggressive, the latter can be treated with leukeron albeit not cureable it can produce a long remission. 

I will write more later. Even just thinking about our year with Toby makes me cry, especially navigating the medical side of it which you can see from the thread if you have the stamina to plow through it. But seriously, I would run, not walk, to the referral from LDG. I wish I had lived where you do. The only chemo that ever really helped Toby and even made his fur better was the rescue chemo after the protocol he was given was only partly successful. And the rescue chemo that they gave Toby and that helped him, is what LDG's doc used as the regular long term chemo that saved her boy Lazlo. But that isn't the point- the reason you need to go there is so you don't waste money on an unknown doctor. Believe me, it can happen because it happened to us. The doc who referred us to the bad place is published and well known, she treats Oprah's dogs. Even she did not know they were bad. Now she knows, especially after the oncologist quit towards the end of Toby's treatments and moved to Arizona, and the practice decided not to bring in a new oncolgist for another 6 months, leaving all the cancer patients with only technicians to administer their chemo. And that was just one part of what we went through. 

No matter what you choose, I will be happy to help you with whatever information I can. I would love to give someone the gift of not having to go through what we did. LDG helped me a lot, filling in where the vet should have!

And your dilemma re: an oncologist surgeon wanting a referral and diagnosis versus the non specialist being unable to do the surgery and make a firm diagnosis- you can easily navigate that if you choose to use a different surgeon than LDG's. Just ask your regular vet to make the referral and to provide all the info you gave here in the course of this thread. OR if you have a surgeon you are interested in, just call them up and tell them you have X paperwork to give or to fax from your boy's regular vet, and you would like to do the ultrasound etc. at the surgeon/oncologist's facility where you will be treating your boy since it seems that he indeed has a mass at the very least. You should not experience any problems whichever course you take. 
 
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ldg

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Good points, all, Barb. And :hugs: :hugs: :hugs: :hugs: :hugs:

We both would have loved to hear the word "operable." :nod:

Dan, Barb's got a point. If it turns out Kinny's mass is operable, you may not even need chemo.

Whatever you decide, you've got a support team here. :heart2:
 
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